Non-prescription use of antibiotics among children in urban China: a cross-sectional survey of knowledge, attitudes, and practices

Abstract

There was a high proportion of primary caregivers self-medicate antibiotics for children in urban China, despite their insufficient knowledge about antibiotic use. Public health initiatives are needed such as public education campaigns and stricter government regulation of antibiotic use and availability in community pharmacies.

A cross-sectional study of antibiotic misuse among Chinese children in developed and less developed provinces

“…Despite equal proportions of parents in Zhejiang and Shaanxi choosing selfmedication or going to a doctor, results were significantly different on the subject of antibiotic use. Consistent with previous research [11], our study found that parents in the less developed Shaanxi province were more likely to keep antibiotics at home and to give their children antibiotics as SMA or prophylaxis. These findings mirror a study in Europe, which showed storing in-home antibiotics and self-medicating with antimicrobial drugs were more prevalent in less developed countries [32].…”

“…In China, previous studies have found regional disparities in parental understandings of and attitudes towards antibiotic use. Fewer caregivers in the less developed city of Xi'an recognized antibiotics as prescription drugs, while many more agreed that they could self-medicate their children with antibiotics for minor illnesses compared to their counterparts in the more developed city of Shanghai [11]. Also, it has been reported in Jiangxi, a less developed province in central China, that nearly 80% of parents believed antibiotics could cure viral infections, and about 50% thought antibiotics would help shorten the duration of upper respiratory tract infections [12].…”

“…One study mentioned that the location of a child's residence in China might influence the rate of antibiotic misuse by his/her caregiver [20]. In accordance with that, another research in urban China found that children from an eastern city were much less likely to receive non-prescription antibiotics from caregivers than their counterparts from a western city [11]. It was also reported that regional economic statuses in China have corresponding rates of antibiotics sales in hospitals [26].…”

“…Furthermore, children are grouped together in nurseries and schools, catalyzing the spread of drugresistant bacteria [6]. Antibiotics are commonly used for children with viral upper respiratory tract infections, despite the fact that these diseases are self-limiting and do not respond to antibiotic therapy [10,11]. Antibiotic misuse and AMR are most prevalent in low and middle income countries due to these countries' greater burden of infectious diseases and weaker public health systems [12].…”

“…On the supply side, antibiotics are frequently prescribed to children during pediatric consultations [15][16][17] and nonprescription antibiotics are widely available at community pharmacies [18] despite prohibitory regulations [14,19]. On the demand side, many parents and caregivers admit to keeping antibiotics at home [10][11][12] and giving children antibiotics without seeing a doctor, which is a form of self-medication with antibiotics (SMA) [11,12,20,21]. SMA can be wasteful and harmful, and home-stored antibiotics provide a reservoir for it [22].…”